Over the course of its 69-year history, the Soviet Union was notorious for its heavy-handed suppression of political dissent — most infamously through its use of the Siberian GULAGs. But it was during the 1960s and 1970s that the Communist Party took their intolerance for ideological deviance to extremes by diagnosing and institutionalizing so-called counterrevolutionaries with mental illness. It was a frightening episode in Soviet history in which perfectly healthy citizens could be deemed psychotic simply on account of their political views.

And indeed, what better way to deal with activists and naysayers than to diagnose them as being mentally unstable. Dissenters, who were often seen as both a burden and a threat to the system, could be easily discredited and detained.

Moreover, it served as a powerful and disturbing way to convince the masses that they needed to adhere to the party line — and that any deviant thinking was surely a sign of mental instability. As Nikita Khrushchev noted in 1959, it should be impossible for people in a communist society to have an anti-communist consciousness, and "Of those who might start calling for opposition to Communism on this basis, we can say that clearly their mental state is not normal."

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Consequently, it was around this time that Soviet definitions of mental disease were expanded to include political disobedience. But in the end, all it ever amounted to was a form of political abuse and repression. Anti-Soviet activists were not mentally ill — but instead the victims of politically inspired pseudoscience and the misuse of psychiatric diagnosis.

"Politically defined madness"

The advent of Soviet psychoprisons coincided with the rise in power and influence of the KGB, the infamous secret service wing of the Communist Party. They started to take an interest in medicine as a potential instrument of control as early as 1948 under the Stalin regime. The use of GULAGs was starting to fall out of favor, so it was around this time that the high-ranking KGB officer Andrey Vyshinsky ordered the use of psychiatry as a way to both quash dissent and still send a message to any would-be activists.

Indeed, psychiatry had great potential as a control mechanism — more so than other areas of medicine. The Communist Party was eager to take advantage. They knew that a diagnosis of mental illness could confer them broad powers by allowing them to detain persons against their will conduct therapy — all while proclaiming it to be within the interest of the "patient" and the broader interests of society.

Called psikhushkas, Soviet psychiatric wards were a place where dissenters could be both confined and treated for their perceived conditions. Psikhushkas soon became an integral part of the larger psychiatric system, in which genuine psychiatric science worked in parallel with the politically imposed version. To a degree, it became part of a two-tiered system in which psychiatry was used as a form of political repression (primarily operating out of the Moscow Institute for Forensic Psychiatry) and a more genuine psychiatry (as practiced in the Leningrad Psychoneurological Institute). Once in full swing, the new system became integrated in hundreds of hospitals across the Soviet Union.

The campaign adopted a greater sense of mission during the late 1960s when open dissention started to become more commonplace, most notably through the agitation of such thinkers and activists as Alexander Solzhenitsyn and Andrei Sakharov. KBG chairman Yuri Andropov, who went on to become Premier, called for a renewed struggle against "dissidents and their imperialist masters." To that end he outlined and implemented a plan that went into effect in 1969. Looking to wipe out political dissent in the Soviet Union once and for all, Andropov made sure that psychiatry would continue to be used as a tool in the struggle.

Specifically, he issued a decree on "measures for preventing dangerous behavior (acts) on the part of mentally ill persons." Consequently, psychiatrists were both empowered and expected to diagnose and confine anyone who fit the description of a political agitator. Doctors were even told to "haul" or "entrap" suspected dissenters, thus making them not only de facto arresting officers, but interrogators as well. Psychiatrists were compelled to come-up with diagnoses, allowing the police and the state to forego inconveniences such as due process and court judgments (such that they were at the time).

Sluggish schizophrenia

That said, Soviet doctors did use formal procedures to diagnoses their patients. The state, with the help of some overzealous psychiatrists, was considerate enough to provide a list of symptoms that could be used to make a diagnosis.

The most common of these was a condition called "sluggish schizophrenia," a psychological disorder that was developed by Andrei Snezhnevsky at the Moscow School of Psychiatry. Snezhnevsky agreed with the Communist Party's sentiment that citizens who opposed the Soviet regime must be mentally unwell since there could be no other logical rationale why anyone would oppose the world's greatest sociopolitical system.

Consequently, he came up with a form of schizophrenia that not only characterized political deviance as a failure to properly grasp reality, but one that could very easily be applied to anyone exhibiting contrarian tendencies. Specifically, they described it as "a continuous type [of schizophrenia] that is defined as unremitting, proceeding with either a rapid ("malignant") or a slow ("sluggish") progression and has a poor prognosis in both instances."

In other words, it was a pervasive, subtle, and pernicious kind of schizophrenia that couldn't be cured. Moreover, psychotic symptoms were not required for the diagnosis. Psychiatrists were told to look for other underlying conditions, such as psychopathy, hypochondria, and anxiety. But they were also on the lookout for such socially reprehensible traits like pessimism, poor social adaptation, conflict with authorities, "reform delusions," perseverance, and "struggles for truth and justice" — traits that could, on their own, be sufficient for a diagnosis.

According to Snezhnevsky, patients with sluggish schizophrenia could go unnoticed by the untrained eye and pass for regular folk — that they were "quasi-sane." It was only through a proper diagnosis by a trained professional that they could be identified.

In reality, it was a tool to isolate and imprison hundreds or thousands of political prisoners from the rest of society, discredit their ideas, and break them physically and mentally. It was nothing less than torture.

The imprisoned

The human toll inflicted by Soviet psychoprisons is one that's largely lost in history, but significant nonetheless. Some survivors, such as Viktor Nekipelov, have gone on to suggest that the those involved were "no better than the criminal doctors who performed inhuman experiments on the prisoners in Nazi concentration camps."

As for the exact scale of the practice, it is difficult to discern the numbers — but as work by historians continues a picture is starting to emerge.

According to the archives of the International Association on the Political Use of Psychiatry, no less than 20,000 citizens were hospitalized for political reasons — a number that most historians agree is likely low on account of unreleased documentation (there are a lot of people alive today who could be badly implicated by this information).

What is known is that, with the rise of Mikhail Gorbachev in the 1980s, the practice was (mostly) discontinued, leading to the release of many political prisoners. The year 1986 saw the release of 19 prisoners, followed by 64 in 1987. In 1988, it was announced that, of the 5.5 million Soviets listed on the psychiatric register, over 30% would be taken off the list. A year later the number was revised and shown to be closer to 10.2 million people registered at "psychoneurological dispensaries" — along with a whopping 335,200 hospital beds set aside.

And sadly, the practice has not gone completely out of favor in today's Russia, with some concerned that punitive psychiatry is making a comeback.

Disturbing episode for all of psychiatry

While it might be easy to dismiss this chapter of Soviet history as an interesting consequence of totalitarian and authoritarian politics, it also serves as a disturbing reminder of the normative nature of psychiatry and the assessment of psychiatric disorders. Mental health is a culturally sanctioned thing. Our definitions of mental health change over time depending on the values and morals of the society in question.

Today, our concerns are with those people who pose a threat to themselves and impose a burden on society, and in turn we've come to pathologize such things as gambling, depression, anxiety, and overeating. Looking to the future, it's not ridiculous to think we might do the same for shyness, extreme religious beliefs, or racial bigotry. But given the diversity of human culture and individual experience, could we ever in all fairness agree upon and impose a singular vision of what's mentally normal?